Prevalence of Allergic Rhinitis in Children in the Trabzon Province of the Black Sea Region of Turkey
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Turkish Archives of Otorhinolaryngology Turk Arch Otorhinolaryngol 2016; 54: 21-8 21 Türk Otorinolarengoloji Arşivi Prevalence of Allergic Rhinitis in Children in the Trabzon Province of the Black Sea Region of Turkey Hatice Bengü Çobanoğlu1, Abdülcemal Ümit Işık2, Murat Topbaş3, Ahmet Ural2 1Department of Otorhinolaryngology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey 2Department of Otorhinolaryngology, Karadeniz Technical University School of Medicine, Trabzon, Turkey Original Investigation 3Department of Public Health, Karadeniz Technical University School of Medicine, Trabzon, Turkey Abstract Objective: We aimed to determine the prevalence Results: The prevalance of allergic rhinitis in children of allergic rhinitis in children aged 12-15 years who between 12 and 15 years age was found to be 14.5% in lived in the Trabzon Province, specify possible risk Trabzon. Female gender was found to be a relative a factors, and compare the data obtained with those risk factor for allergic rhinitis (p=0.015). The prevalence of the other studies conducted in our country and in of allergic rhinitis in children whose both parents were smoking was significantly higher than that in children other countries. whose only one parent was smoking or both parents Methods: First, 1372 students from nine primary were nonsmokers (p=0.0024). In addition, living in an schools determined according to the recommendations apartment flat (p=0.015) and owing pets (p=0.04) were of Department of Public Health and approval of The detected to be other risk factors for allergic rhinitis. Provincial Directorate of Health were screened in their Conclusion: According to our investigations, this is schools with questionnaire forms. Second, students the first prevalence study in Trabzon, which is the providing the response “yes” to the first and/or second largest settlement in the Eastern Black Sea Region. questions in the questionnaire forms were considered The prevalence of allergic rhinitis in children was as possible allergic rhinitis patients and invited to our found to be 14.5%. Female gender, smoking habits of clinic. Then, 246 students were subjected to a skin prick the parents, owing pets, and living in an apartment flat are risk factors for allergic rhinitis. test. Data were collected with the evalution of ques- tionnaire and skin prick test results together. Keywords: Allergic rhinitis, prevalence, pediatric Introduction and Provincial Directorate of Health in Trabzon Allergic rhinitis is a globally observed disease that city center to specify the possible risk factors and can severely affect the quality of life. It includes to compare the data obtained with those of other an intermittent type that is observed in the pol- studies performed in other cities of Turkey as well len season and a persistent type that continues as other countries. throughout the year. Allergens vary according to the climates and countries (1). Diagnosis can be This study was performed to determine the preva- performed with a good medical history, physical lence of allergic rhinitis in students aged 12–15 years examination, and skin test. The complaints of pa- old in the Trabzon city center. tients can be minimized by protection from aller- gens and by appropriate medical treatment (2). Methods Nine primary schools were specified at the city In recent years, an increase in allergic diseases according to the recommendations of the Pro- This study was presented at the 32nd National Otorhinology Head and Neck preoccupies the role of environmental factors. vincial Directorate of Health and the approval of Surgery Congress as an oral presentation, 27-31 October 2010, Antalya, Turkey. However, among thousands of environmental the school managements in 2010. The study was Address for Correspondence: factors, the exact factor remains unknown. approved by the Karadeniz Technical University Hatice Bengü Çobanoğlu, Findings regarding the role of smoking, exhaust Ethics Committee (file no: 2009/36). E-mail: [email protected] Received Date: 23.06.2015 gas, air pollution, and living in hygienic conditions Accepted Date: 07.02.2016 have been reported (3). Because no similar study Based on the population of the city where this © Copyright 2016 by Official Journal of the Turkish has been performed in our region so far, we study was conducted, approximately 1300 students Society of Otorhinolaryngology and Head and Neck Surgery Available online at planned to screen 1372 students aged 12–15 years were recommended for screening in order to meet www.turkarchotorhinolaryngol.org from nine schools. The schools were determined the statistical sufficiency required by the Depart- DOI: 10.5152/tao.2016.1089 together with the Department of Public Health ment of Public Health. 22 Çobanoğlu et al. Allergic Rhinitis Prevalence in Trabzon Turk Arch Otorhinolaryngol 2016; 54: 21-8 The Department of Public Health suggested screening of the Results 12–15-year-old age group in the consideration of reliability of The questionnaire survey was provided to 1372 students (female, the responses to the questionnaire items and easier cooperation n=712, 52%; male, n=658, 48%), and two students were exclud- during prick tests. Our study consisted of two stages. In the first ed from the study because of psoriasis. Nearly half (145/291, stage, students were scanned at their schools using the “Ques- 49.8%) of the students had marked the “yes” option for the first tionnaire method.” The questionnaire was prepared by taking the or second question in the questionnaire. In other words, these questions on the official site of the European Allergic Rhinitis patients had allergic rhinitis before or they were sneezing, had and Asthma Committee (ECRHS) as the base (4). Question- nasal drainage, or had nasal obstruction and indicated that they naire items included house environments, bedrooms, pet habits, had used drugs before for complaints of sneezing, nasal drain- status of allergic complaints according to the seasons, age of the age, and nasal obstruction. mother, and smoking status of the parents (Figure 1). The students (n=291) who had marked the “yes” option for the A total of 1372 students at the city were given this survey. Approvals first or second question were called to our clinic for the skin from the management of the primary schools were obtained, and prick test, and this test was performed for 246 of them. Some upon this approval, written consents of the families were also (n=192) of the students with positive prick test results were di- obtained before handing out the questionnaires to the students agnosed with allergic rhinitis. in their classrooms. Students responding “yes” to the first and/or second questions in the questionnaire were considered as potential When the findings of the skin prick test and questionnaire were allergic rhinitis patients and were invited to our clinic for a prick evaluated together, the prevalence of allergic rhinitis was found test. Before the prick test, consents of their families were obtained. to be 14.5%. Investigation of the other factors and statistical Information about antihistaminic or other drug usage, which could evaluation were performed in these patients (Table 1). degrade the test results of the questionnaire survey, was obtained, and the students were warned not to use any drugs before coming Allergy–Gender: Among the students who were accepted as to our clinic for the prick test. In this group, two students had having allergic rhinitis according to the evaluation of the re- psoriasis; therefore, the test could not be performed on them. The sponses to the questionnaire items and findings of the skin prick test was routinely performed using 24 standardized Alk- prick test, allergic rhinitis was found in 115 (16.8%) female and Albio (ALK; Berkshire, UK) Allergens. Allergens were applied 77 (12.1%) male students. It was observed that female gender to both arms and penetrated into the subcutaneous layers via a was a significant risk factor for the diagnosis of allergic rhinitis lancet. After waiting for 15 minutes, the allergens that induced (p=0.015). an induration with a diameter equal to or greater than that of the control allergen histamine were accepted as the specific allergen Allergy–Smoking Habits of the Parents: Parents of 616 stu- responsible for the development of allergic rhinitis. During the dents (46.7%) were nonsmokers. Fathers of 438 students 15-minute waiting period in our clinic, students were accompanied (33.2%) and mothers of 96 students (7.2%) were the only smok- by an attendant, and emergency kit and drugs were kept ready in ers in the family, while both parents of 169 (12.8%) students case of any possible anaphylaxis or allergic reaction. were smokers. The relationship between the smoking habits of the parents and allergy was also investigated. Allergic rhinitis Our study is summarized by a flow chart (Figure 2). With the was detected in 12.2% of the children whose parents were non- findings of the prick test and questionnaire, the correlations be- smokers. The rates of allergic rhinitis in children whose father, tween allergic rhinitis and factors such as smoking habits of the mother, or both parents were smokers were 15.5%, 13.5%, and parents, heating system in the house, room share in the house, 21.3%, respectively. The prevalence of allergic rhinitis in children seasonal variations in the symptoms of allergic rhinitis, type of whose mother and father were both smokers was significantly residence, owning pets, and age of the mother were determined. higher than that in children whose only one parent was a smok- er or both parents were nonsmokers (p=0.04). Statistical Analyses Data were analyzed using the Statistical Package for the Social Allergy–Heating Devices Used in the House: The students Sciences (SPSS) software program (version 12.0 for Windows) were using room heaters (n= 358: 26.1%), the central system (SPSS Inc.; Chicago, IL, USA).